The International Journal of Romanian Society of Endocrinology / Registered in 1938

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October - December 2021, Volume 17, Issue 4
Case Series

Nguyen K, Chen X, Hughes T, Hofflich H, Woods GN, McCowen KC

Surprisingly Few Women with Severe Osteoporosis by Bone Densitometry Undergo Workup for Secondary Causes - a Retrospective Evaluation

Acta Endo (Buc) 2021, 17 (4): 537-542
doi: 10.4183/aeb.2021.537

We describe clinical features of women with extremely low bone density, and investigate secondary causes of osteoporosis. Our hypothesis was that this population would be enriched in identifiable causes of osteoporosis. We performed a retrospective review of medical records of all women seen at our university over 4 years with T-score on bone densitometry at/below -4 at any site. Historical and fracture details were abstracted. We considered a thorough work up to include Vitamin D, PTH, CBC, chemistry panel, cortisol, transglutaminase, myeloma screen, tryptase and 24-hour urine calcium. Results. 137 women were identified with T-score at/below -4. Percent identified as Asian was 26% (higher than local prevalence of 8%). Average BMI was 21.6 kg/ m2. Clearly identifiable causes of osteoporosis were noted in 57% (inflammatory disorder, glucocorticoid or antacid exposure, prolonged immobilization and alcoholism were most prevalent). Of the remainder, full work up was performed only in 8%. Endocrine consultation and white race predicted thoroughness of secondary work-up. Conclusion. Fragility fractures, leanness and Asian race were common in women with very low T-score. However, few new causes were identified. Underlying etiology was either immediately evident or inadequately studied, especially in minorities.

Keywords: osteoporosis, T-score, secondary causes, bone densitometry.

Correspondence: Karen Mccowen MD, University of California San Diego, 9500 Gilman Drive, La Jolla, La Jolla, California, 92093- 0021, United States of America, E-mail: